Amends GS 108D-1 to define adverse benefit determination (as defined in 42 CFR 438.400(b)), and to redefine contested case hearing to refer to adverse benefit determinations instead of managed care actions. Deletes the definition of managed care action. Replaces the term "notice of managed care action" with "adverse benefit determination."
Extends the period of an enrollee's right to request an LME/MCO level appeal to no later than 60 days (currently 30 days) after the mailing date of the required notice of an adverse benefit determination.
Directs LMC/MCO to resolve the appeal and provide written notice of resolution no later than 30 days (currently 45 days) after receiving the request.
Authorizes enrollees to request a contested case hearing if appeals have been exhausted under either GS 108D-14 or 42 CFR 438.408(c)(3) (currently just GS 108D-14).
Directs LME/MCO to resolve an expedited appeal and provide written notice of resolution no later than 72 hours after receiving the request (currently three working days).
Authorizes enrollees to request a contested case hearing if appeals have been exhausted under GS 108D-13 or GS 108D-14, or under 42 CFR 438.408(c)(3). Authorizes enrollee to file a request for an appeal to the Office of Administrative Hearings no later than 120 days (currently 30 days) after the mailing date of the notice of resolution.
Makes conforming changes, including replacing the term "managed care action" with the term "adverse benefit determination."
CONFORMING CHANGES LME/MCO GRIEVANCES/APPEALS.
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View NCGA Bill Details | 2017-2018 Session |
AN ACT TO MAKE CHANGES TO THE NORTH CAROLINA LME/MCO ENROLLEE GRIEVANCES AND APPEALS STATUTES TO CONFORM WITH RECENT CHANGES TO THE FEDERAL LAW.Intro. by Hise, Pate, Krawiec.
Status: Re-ref Com On Health (House Action) (Jun 13 2017)
Bill History:
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Wed, 1 Mar 2017 Senate: Filed
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Thu, 2 Mar 2017 Senate: Passed 1st Reading
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Thu, 2 Mar 2017 Senate: Ref To Com On Rules and Operations of the Senate
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Tue, 21 Mar 2017 Senate: Withdrawn From Com
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Wed, 5 Apr 2017 Senate: Reptd Fav
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Wed, 5 Apr 2017 Senate: Re-ref Com On Rules and Operations of the Senate
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Thu, 6 Apr 2017 Senate: Reptd Fav
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Mon, 10 Apr 2017 Senate: Passed 2nd Reading
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Mon, 10 Apr 2017 Senate: Passed 2nd Reading
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Mon, 10 Apr 2017 Senate: Passed 3rd Reading
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Mon, 10 Apr 2017 Senate: Passed 3rd Reading
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Tue, 11 Apr 2017 Senate: Regular Message Sent To House
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Tue, 11 Apr 2017 House: Regular Message Received From Senate
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Thu, 13 Apr 2017 House: Passed 1st Reading
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Thu, 13 Apr 2017 House: Ref To Com On Rules, Calendar, and Operations of the House
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Tue, 13 Jun 2017 House: Withdrawn From Com
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Tue, 13 Jun 2017 House: Re-ref Com On Health
S 161
Bill Summaries:
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Bill S 161 (2017-2018)Summary date: Mar 1 2017 - View Summary
View: All Summaries for Bill